WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

patients with strong personal convictions about the
menopause and their need for medication. The
provider must be prepared to discuss a variety of
menopause or age-related topics, and decide what
to recommend for a specific woman—often in less
time than ever before.
The menopause offers
the health care provider
an opportunity to
assess each woman’s
health, her concerns,
and the need for health
promotion and disease
prevention measures.
Recent research findings include:
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Recommendations should
be specific to each woman
and her background. There
are country-specific and
cultural variations in
menopause symptoms, the
frequency of different
postmenopausal diseases,
clinical practice, health
care resources, and affordable
interventions.
Country- and culture-specific
practice will therefore
vary, and appropriately so.
• Increasing recognition of the need to address
health promotion beyond the perimenopausal
years, and in women with and without
menopausal symptoms.
• The risks and benefits of lifestyle, pharmacological,
and surgical interventions may change as
women age.
• The tailoring of menopausal treatment to the
individual woman should be based on her individual
clinical profile and concerns.
• For the treatment of the climacteric syndrome,
HRT remains the most effective pharmacologic
intervention.
• The long-term benefits and risks of HRT
continue to be assessed.
• HRT for long-term health promotion, as for
osteoporosis, usually requires its continued use.
• New nonhormone therapies offer more options
for prevention of common menopausal conditions,
to be tested fully in clinical trials.
• Preventive drug therapy can start many years
after menopause, particularly with respect to
osteoporosis. This, however, may not be optimal.
• The risk for many disease outcomes can be
reduced even in old age.
Research results are teaching us to be cautious
before assuming that current practice is best. For
example, although HRT remains the gold standard
for the treatment of vasomotor and urogenital
symptoms, as well as for the prevention of bone
loss, recent clinical trial results have failed to show
benefit for other menopausal conditions, such as
incontinence.
Past perceptions about
appropriate indications for
the use of HRT were based
almost entirely on clinical
experience and observational
data. These perceptions
are being questioned
as new knowledge emerges
from clinical trials. Some
examples follow:
The long-term
benefits and
risks of HRT
continue to
be assessed.
Perception: HRT protects against coronary
heart disease.
Evidence: The prospective randomized clinical
trials reported so far have not shown
benefit for reducing coronary events
in secondary prevention.